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Chronic anticoagulation — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Chronic anticoagulationUSMLE Step 3

A 27-year-old with asthma has received 1 hour of continuous nebulized albuterol, repeated ipratropium, systemic glucocorticoid, and oxygen. He remains alert but speaks in words, has a peak expiratory flow of 28% predicted, and has no pneumothorax. Which next step is most appropriate?

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Correct answer: D — Give intravenous magnesium and continue bronchodilators under intensive-care monitoring

The best answer is “Give intravenous magnesium and continue bronchodilators under intensive-care monitoring”. Persistent severe obstruction after intensive inhaled therapy and systemic glucocorticoid warrants adjunctive IV magnesium and ICU-level reassessment. Aminophylline and routine antibiotics are not recommended rescue therapies; sedation can precipitate respiratory failure. Intubation is prepared if fatigue, hypercapnia, or mental-status deterioration develops. The alternatives are less suitable because they mistime the intervention, omit a necessary component, or apply treatment for a different physiologic problem; the stem's decisive findings determine the sequence.

Reference: NHLBI, Expert Panel Report: Managing Asthma Exacerbations: https://www.ncbi.nlm.nih.gov/books/NBK7228/